The project has two components: education of registered nurses to function as family nurse practitioners in a variety of ambulatory care settings and the evaluation of the effect of graduates on selected aspects of the health care system. The development and evaluation of the educational program has continued to be a joint effort of faculty of the School of Nursing and the Medical College. The primary dependent variable in the educational effort (the PRIMEX graduate) becomes the principal independent variable (treatment) in the health services research. The health services research component of the PRIMEX program has the following objectives: (a) Describe the roles assumed by the graduate nurse practitioners in the various medical care settings, particularly the functions served in the delivery of health care and the ways in which the extended role skills are put to use. (b) Assess the impacts of the nurse practitioners on the following, where relevant and measurable: quantity of health services delivered; quality of health care, including comprehensiveness; cost to the employing agency. (c) Assess the sociological aspects of the nurse practitioner role, including: patient acceptance; acceptability to other providers; nurse practitioners' job satisfaction and attitudes; barriers to maximum utilization of the extended role skills and role problems encountered; trends in role development; career patterns.